The Implications of a Chronic Shortage of Nurses

Understaffing is the Number One Challenge Facing Nursing Today

The most pressing challenge in nursing today is the profound adverse impact of chronic understaffing on both patient care and nurse well-being. This issue is not just about numbers on a staffing sheet, but rather it is the heart-wrenching reality faced by far too many nurses on every shift, every day. When walking into a nursing ward and seeing individual nurses responsible for six or seven patients instead of the recommended four, it is reasonable to suggest that they will not be able to provide each person with the nursing attention they need and deserve (Speakman, 2020).

Unfortunately, the problem is getting worse. Across the country, front-line nurses make difficult and even impossible choices every day: Do I spend extra time comforting the elderly patient who is confused and afraid, or do I rush to administer overdue medications to three others? Should I take my much-needed break, or use that time to finally complete my documentation? These are not choices anyone should have to make when human lives are involved, but most especially nurses who are committed to helping others. Indeed, one hard-pressed nurse has “spoken of praying nothing bad happened on a night shift when left as the only one able to administer morphine while in charge of 37 patients” (Rachel, 2017, p. A1).

Not surprisingly, the ripple effects of understaffing are devastating. Understaffing can cause a myriad of otherwise-preventable problems. For example, medication errors increase when nurses are understaffed (Plevová et al., 2020). Compounding this problem is the fact that far too many nurses are reluctant to report medication errors for fear of punishment as well as a fundamental lack of management support. In this regard, a study by Alotaibi (2024) concluded that, “Efforts should be directed toward implementing interventions that address high workloads, enhance staff education and awareness, and promote a workplace culture conducive to reporting errors without fear of repercussions” (p. 221).

Healthcare organizations should create an environment where nursing staff feel safe reporting mistakes. Strong support structures help nurses grow professionally and take part in improving medication safety. Leaders must tackle heavy workload issues while building staff knowledge and skills. The focus should be on making positive changes through open communication rather than punishment (Alotaibi, 2024). When nurses can report concerns freely and get constructive feedback, patient care becomes safer. Professional growth opportunities let nurses contribute meaningfully to better medication practices. The goal is continuous quality improvement through engaged staff who are not afraid to speak up when issues arise (Alotaibi, 2024).

Likewise, an important Joint Commission measure, patient satisfaction, plummets when we can only spend a few hurried minutes in each room. Preventable complications rise because nurses are unable to monitor patients as closely as needed. For example, a study by Plevova et al. (2020) of the implications of nursing understaffing on patient care and found, “The most frequently reported factor influencing the occurrence of missed care was understaffing and the related number of patients per nurse, resulting in a lack of time for selected patient activities” (p. 32). It is therefore little wonder that increasing numbers of nurses are suffering from the emotional toll and subsequent burnout that these poignant and painful experiences evoke Plevova et al., 2020).

The brutal irony is that understaffing creates a vicious cycle. When nurses are overworked, many burn out and leave the profession entirely. This increases the burden on those who remain, leading to more burnout and even more departures from the profession (Peutere et al., 2024). In sum, healthcare organizations of every ilk need to invest in recruiting and retaining nurses who know their facilities and communities (Scales, 2020).